Patient Instructions — 53-YEAR-OLD CLEANER

You are a 53 year old cleaner. Use appropriate DOB

You have noticed some tingling and numbness in your feet over the past month. The tingling feels like a pins and needles sensation, which comes and goes without any obvious pattern however sometimes it feels numb (no feeling at all). You have not had any trauma or injury that you can recall, however about a week ago you noticed a small blister on the bottom of your right foot, you do not remember getting it. If specifically asked - the blister appeared red, pea sized and was not particularly warm to the touch, there was no bleeding or pus. It has not changed in appearance since you first noticed it, you have tried applying savlon (antiseptic cream) daily for the past few days without any improvement. You have not tried any analgesia because it is not painful, it is not affecting your ability to walk. This is the first time you have experienced any of these symptoms.

You have also noticed some recent numbness and tingling in both hands. Otherwise, you are feeling ok. You don’t have any pain on walking( in the foot or the calf). There is no swelling of the foot or ankle. You do not have any weakness in either leg or foot (your strength is normal). You have not had any previous operations.

You have no stress and you live with your partner in a 4-bed house which you own. You will be going to Skegness on your holiday again this year as you have a holiday home there. You feel very lucky in life, but you are worried that these symptoms could be significant you just want to know that it’s all ok.

I – You’re not sure but wondered if it might be related to the cleaning products

C – You are worried the tingling could get worse, you may have to miss your holiday in Skegness

E – You just want to know it’s all ok

You have 2 children who are grown up and living round the corner from you.

You have been putting on weight and haven't noticed any bleeding or tiredness (If you are female your periods stopped some years ago now). You are not passing urine more than normal. You have no back or neck pains.

You have type 2 diabetes, high blood pressure, high cholesterol, you are taking tablets for these conditions, but you can’t remember their names and often miss doses due to your work. You have no allergies.

You drink a couple of glasses of wine a week and you smoke 5 a day. You do not tend to do any formal exercise, but you are always on your feet in your cleaning job. You do not have a vegan diet, you do not take any supplements. You tend to snack a lot (chocolates and sweets) and often have a ready meal because you don’t have time to cook.

Your mother was diagnosed with diabetes when she was in her mid 50’s and have been on metformin ever since.

If specifically asked: You have not been to the diabetic foot nurse, you have not had a recent hba1c test and you cannot remember your last test. You have no other symptoms (e.g. chest pain, shortness of breath)

You will not be expected to be examined and should come dressed as a 53-year-old cleaner.

Your demeanour is friendly and approachable, but you do not understand about health things. You should answer questions as they are asked i.e. if it is an open question then answer openly, if it is a closed question then please answer with a yes/no/maybe. Only give information when it is specifically asked. Please be fairly succinct as the students only have 6 minutes for this.

Your opening statement should be “thank you doctor I need some help as I am not sure what is going on”.